Marketing for medical products on social media can have misleading tendencies
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Key takeaways:
- Most clinicians used in marketing campaigns on X got paid for endorsement even if disclosure not made.
- Many clinicians had no involvement in research of product they endorsed.
The posts on X (formerly Twitter) looked like advertisements to Aaron P. Mitchell, MD, MPH.
They featured physicians endorsing medical products. Sometimes they had promotion tags, other times they did not.
Disclosures could not always be found, and posts often had a medical-conference design to them.
“It’s not always clear if this is a case where money is changing hands,” Mitchell, genitourinary oncologist and member of department of epidemiology and biostatistics at Memorial Sloan Kettering Cancer Center, told Healio.
Mitchell suspected though, and he and colleagues determined that to be true, according to a study published in JAMA.
They found most of the clinicians they saw on these posts received payments from the manufacturer related to the product they endorsed.
“My expectation going in was that these would, in fact, be paid endorsements, but I wanted to reserve judgment on that until we looked at the Open Payments data in order to validate the potential concerns that I have about this. Now, having seen the data, the concerns are validated,” Mitchell said.
“Part of our concern about these Tweets is that there’s an understanding when you see a doctor in a commercial on television, in accordance with what the FTC says, reasonable people are going to assume that the person appearing in a TV commercial has been paid,” he added. “In these ones that were being disseminated through Twitter, I can’t ascribe intentionality to it, but I think a lot of them had the trappings and the appearance of a more academic presentation of science.”
Surveying the endorsements
Researchers conducted the study searching for physician endorsement of drugs or medical devices on X in 2022. They defined endorsement as participating in a marketing campaign, not simply disseminating an opinion on a product.
“There is a fine but important line in different kinds of endorsements that doctors make about the drugs we use,” Mitchell said. “We all engage in drug endorsement in a looser sense. We have certain drugs that we have experience with certain drugs that we’ve used for our patients with good results or are familiar with the clinical trial data for, and we tell our colleagues about them. That kind of endorsement, more broadly defined, is very much in line with our official role as our patient advocates and as scientists and trying to follow the best data and do so to the benefit of our patients.”
Mitchell and colleagues searched a wide swath of terms to find endorsements on X. They focused on products released in 2021 or 2022 because they would have the highest likelihood of having an advertisement, which they defined as industry-sponsored testimonials, posts, white papers and webinars.
They found 28 clinician endorsers on X in 2022.
Using Open Payments, they determined all those clinicians received at least one general payment, 93% received them from the manufacturer of the product they endorsed (mean payment $27,461) and 86% got them for work relating to the product they endorsed (mean $19,684).
In all, 61% of Tweets had been sponsored testimonials and 32% had no mention of disclosures.
The main reasons for payment included speaking (77% of total funds paid) and consulting (16%).
Researchers also measured clinicians’ academic productivity using the H-index and found them to have a median score of 15 (20 or above considered accomplished).
Half of the endorsers had no publications related to the product they endorsed.
The PhRMA Code on Interactions with Health care Professionals states, “Decisions regarding the selection or retention of health care professionals as consultants should be made based on defined criteria such as general medical expertise and reputation, or knowledge and experience regarding a particular therapeutic area.”
“We found that, by and large, most of these doctors did not really have any relevant research expertise from which to be making their endorsement,” Mitchell said. “Certainly not saying they’re bad doctors, but from the criteria that PhRMA puts out, we’re supposed to be hiring people who are the recognized leaders in the field. For the most part, these 28 physicians were not the academic leaders in the field.”
Only one clinician received payment for research related to the endorsed product.
“To sign your name on as an endorser of a given drug, you’re endorsing the drug not to the benefit of the patient, but to the benefit of the company,” Mitchell said.
Collaboration with restrictions
Mitchell emphasized that this concern exists on any platform, whether that be television, print or social media, but social media posts have more “room to mislead.”
“The content of the ad itself I wouldn’t say was qualitatively different or more dangerous than in other media,” he said. “In most cases it was, ‘This is a great drug for patients.’ I do think that the transparency was less in line with what we found [in other media].”
Researchers noted limitations of the study included the sample size and only investigating X.
Mitchell would like to see other platforms evaluated.
“I’m seeing them more and more on Facebook, which is the other app I check on occasion, and every time I do there’s a specific ad for a specific breast cancer drug, that is, without fail, the number one thing in my feed,” he said. “I’m very used to the faces of the two physicians who endorse this drug.”
He said future studies could also evaluate why clinicians choose to endorse products in this fashion.
“What was your thought process in joining with a drug company in this way? Did you previously use this drug and really believed in it? Did they kind of cold call you and you figured, hey, why not? What was the thought process? I’m really curious about what we might learn from the physicians themselves,” Mitchell said.
He does not believe clinicians should be barred from collaborating with pharmaceutical companies, but restrictions should exist.
“Continue to allow physicians to collaborate, sometimes through paid contractual agreements with pharma when they are contributing scientifically to innovation and the development of new products,” Mitchell said. “Then substantially restrict physician engagement in more marketing arrangements, such as the kind that we’re studying here. I think that would be a way to preserve the real scientific engagement, which we all value, while I think achieving a reduction in just the marketing and advertising aspects of the pharmaceutical industry.”
And he encouraged clinicians approached to be marketers to simply say no.
“You can decline,” Mitchell said. “You can say no about participating in advertising. You say, ‘No, I think you have made some great products. I will continue to speak favorably about them in appropriate clinical context when they will benefit patients, but I’m not going to join an advertising campaign.’”
For more information:
Aaron P. Mitchell, MD, MPH, can be reached at mitchea2@mskcc.org.
References:
- Code on interactions with health care professionals. Available at https://phrma.org/-/media/Project/PhRMA/PhRMA-Org/PhRMA-Org/PDF/P-R/PhRMA-Code---Final.pdf. Accessed Aug. 3, 2024.
- Persaud S, et al. JAMA. 2024;doi:10.1001/jama.2024.7832.
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